The International Journal of Stroke is the flagship publication of the World Stroke Organization.

Friday, February 3, 2017

Why Stroke Prevention Needs Overhaul

Tackling the world’s second biggest killer
requires new approaches to prevention and risk management says World Stroke
Organization Board Member Prof Valery Feigin.

The past 25 years have seen the global burden of
stroke rise exponentially. Stroke is increasingly affecting low and middle
income, with an incidence pattern that shows significant differences based on
gender and ethnicity and an increasing number of strokes among younger people.
Despite all our best efforts around primary stroke prevention our current approaches
to prevention, screening and risk management clearly aren’t hitting the mark.

Prof Feigin advises that we need to take the following
key steps to get us closer to a world free from stroke.

1 Increase awareness

Despite being the second biggest killer globally,
public awareness of stroke risks and how to manage them is still low.
Coordinated global and national campaigns that raise awareness of how to reduce
and manage individual stroke risks have the potential to deliver significant
gains in stroke prevention.

2 Drop the ‘low risk’
category

80% of strokes happen to people who are considered to
be at low absolute risk of stroke. We need to encourage everyone to take stroke
risk seriously. Telling someone they are ‘low risk’ gives false reassurance and
doesn’t provide the motivation people need to take the risks seriously and take
steps to address them.

3 Manage high blood
pressure

Uncontrolled high
blood pressure increases a person's stroke risk by four to six times. Addressing high blood
pressure as a contributing factor to stroke would result in a significant
reduction in strokes. However, the decision on whether to treat for high blood
pressure is currently based on an overall calculation of high-risk
cardiovascular disease. Someone with hypertension may not receive treatment
because their overall five-year risk of CVD is less than 15%. We need to look
at this.

4 Improve screening tools

Despite the fact that nearly three quarters of the
global burden of stroke is attributed to lifestyle factors with the exception
of smoking, current stroke screening tools don’t include a number of key
lifestyle factors. We need to improve our screening tools to include
behavioural risk factors such as poor diet, obesity, activity levels and
alcohol intake.

5 Become diversity
sensitive

Globally and within countries our populations are increasingly
diverse. But the models we use to predict levels of risk are largely based on
the Framingham study the subjects of which were largely white, North American.
Addressing the significant differences in stroke rates across ethnicities and
gender is going to require tools that can better predict stroke risks for specific
populations so that these can be more effectively managed.

6 Deliver affordable solutions

The cost of seeing a doctor for CVD assessment, lab
tests and medications that may reduce stroke risk can be a significant barrier
for individuals who lack financial means in high, low and middle income
countries. Low cost risk assessments and management strategies are essential.

Mobile technologies offer promising, accessible,
motivational, educational and validated stroke prevention tools for both
patients and healthcare workers that we need to explore and develop.

7 Implement population
wide preventive strategies

Despite clear evidence of the effectiveness of
population wide strategies, there is still not a single country in the world
that has implemented these in full on a population level. Taxation of tobacco,
sugar and alcohol would not only address incidence of stroke they would provide
revenue to support research, development and implementation of culturally
appropriate approaches to primary prevention.

8 Build partnerships and
advocacy

If we are going to achieve the kind of changes and
interventions that are needed to drive positive behaviours, we need to build
partnerships between healthcare, and government and provide the evidence to
support stronger advocacy from NGOs.

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